Spotlight on... awareness days, weeks and monthsFeaturing the latest research on key areas of health and wellbeing, our Spotlight on... series focuses on the awareness weeks, days and months that occur throughout the year.
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World Hepatitis Day
28 July 2024
World Hepatitis Day, 28 July, is an opportunity to step up national and international efforts on hepatitis, encourage actions and engagement by individuals, partners and the public and highlight the need for a greater global response as outlined in the WHO's Global hepatitis report of 2017. WHO
What is Hepatitis:
UpToDate
Nonviral Hepatitis (auto, alcoholic, drug-induced)
Viral Hepatitis
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Cochrane Library
Clinical Guildlines
Useful resources
Reports
Articles
Autoimmune hepatitis
General
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
E-books
E-journals
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Articles
Autoimmune hepatitis
Comparison of the recommendation of international autoimmune hepatitis pathology group 2022 and the simplified criteria for autoimmune hepatitis 2008: A preliminary study
The 2022 consensus recommendation may be more sensitive in the diagnosis of AIH in comparison to the 2008 ‘simplified’ histological criteria. More studies are needed both for the validation of the sensitivity of the new consensus recommendation and for the determination of the specificity. Hepatology forum 3 July 2024
Diagnosis and management of autoimmune hepatitis
Autoimmune hepatitis is an inflammatory disease of the liver of unknown cause that may progress to liver cirrhosis and end stage liver failure if diagnosis is overlooked and treatment delayed. The clinical presentation is often that of acute hepatitis, sometimes very severe; less frequently, it can be insidious or completely asymptomatic. The disease can affect people of any age and is more common in women; its incidence and prevalence seem to be on the rise worldwide. An abnormal immune response targeting liver autoantigens and inducing persistent and self-perpetuating liver inflammation is the pathogenic mechanism of the disease. A specific set of autoantibodies, increased IgG concentrations, and histological demonstration of interface hepatitis and periportal necrosis are the diagnostic hallmarks of autoimmune hepatitis. Prompt response to treatment with corticosteroids and other immunomodulatory drugs is almost universal and supports the diagnosis. The aims of treatment are to induce and maintain long term remission of liver inflammation. Treatment can often even reverse liver fibrosis, thus preventing progression to advanced cirrhosis and its complications. Most patients need lifelong maintenance therapy, and repeated follow-up in experienced hands improves the quality of care and quality of life for affected patients. BMJ 6 February 2023
Detection of polyreactive immunoglobulin G facilitates diagnosis in children with autoimmune hepatitis
Detecting polyreactive IgG (pIgG) improves the diagnostic evaluation of pediatric autoimmune hepatitis (AIH) compared to conventional autoantibodies, primarily owing to higher accuracy and specificity. Hepatology international 8 July 2024
Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group
Highlights
Journal of hepatology 20 January 2022
Management of autoimmune and viral hepatitis in immunotherapy: a narrative review
The high morbidity and mortality associated with immune-related hepatitis emphasizes the need for screening of underlying diseases, including autoimmune and viral hepatitis, prior to initiation of immune checkpoint inhibitor (ICI). Presence of Auto immune hepatitis (AIH) or chronic viral hepatitis is the most important risk factor for hepatic adverse events in ICI therapy. Screening for AIH, hepatitis B virus (HBV) and hepatitis C virus (HCV) is paramount in patients who will undergo ICI therapy. Annals of palliative medicine 13 September 2023
Value and risk of percutaneous liver biopsy in patients with cirrhosis and clinical suspicion of autoimmune hepatitis
Liver biopsy provides important diagnostic information for the management of patients with cirrhosis and suspected Auto immune hepatitis (AIH), but the procedure is associated with significant risk. BMJ open gastroenterology 15 July 2022
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General
From hepatitis A to E: A critical review of viral hepatitis
Viral infections affecting the liver have had an important impact on humanity, as they have led to significant morbidity and mortality in patients with acute and chronic infections. Once an unknown etiology, the discovery of the viral agents triggered interest of the scientific community to establish the pathogenesis and diagnostic modalities to identify the affected population. With the rapid scientific and technological advances in the last centuries, controlling and even curing the infections became a possibility, with a large focus on preventive medicine through vaccination. Hence, a comprehensive understanding of hepatitis A, B, C, D and E is required by primary care physicians and gastroenterologists to provide care to these patients. The review article describes the epidemiology, pathogenesis, clinical presentation, diagnostic tools and current medication regimens, with a focus on upcoming treatment options and the role of liver transplantation. World of gastroenterology 28 April 2022
New tatt? We're ok with that! Relaxing the tattoo deferral for plasmapheresis donors maintains safety and increases donations
Allowing plasma donations immediately post-tattoo resulted in a substantial donation gain with no adverse safety effect. Lifeblood subsequently reduced the deferral for transfusible component donations to 7 days for tattoos in Australian licensed/regulated establishments. Vos sanguinis 26 June 2024
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Hepatitis A
Hepatitis A: Epidemiology, high-risk groups, prevention and research on antiviral treatment
The hepatitis A virus (HAV) is a leading cause of acute viral hepatitis worldwide. It is transmitted mainly by direct contact with patients who have been infected or by ingesting contaminated water or food. The virus is endemic in low-income countries where sanitary and sociodemographic conditions are poor. Paradoxically, improving sanitary conditions in these countries, which reduces the incidence of HAV infections, can lead to more severe disease in susceptible adults. The populations of developed countries are highly susceptible to HAV, and large outbreaks can occur when the virus is spread by globalization and by increased travel and movement of foodstuffs. Most of these outbreaks occur among high-risk groups: travellers, men who have sex with men, people who use substances, and people facing homelessness. Hepatitis A infections can be prevented by vaccination; safe and effective vaccines have been available for decades. Several countries have successfully introduced universal mass vaccination for children, but high-risk groups in high-income countries remain insufficiently protected. The development of HAV antivirals may be important to control HAV outbreaks in developed countries where a universal vaccination programme is not recommended. Viruses 22 September 2022
Comparison of Anti-Hepatitis A Antibody pharmacokinetics in healthy Australian subjects receiving standard or weight-based dosing of Polyvalent Immunoglobulin
This randomized controlled trial compared two dosing regimens of the polyvalent immunoglobulin available for hepatitis A post-exposure prophylaxis in Australia. Participants were randomized to receive either 270 IU (standard dose) or 3.375 IU/kg (dose by weight). Quantitative serial serum hepatitis A antibody concentrations were measured at baseline and then on days 1, 3, 7, 28, and 50. Fifteen participants completed the trial. Serum hepatitis A antibody concentrations were not different between the study groups at any time point. Pharmacokinetic parameters estimated from participant data were not different between the study groups. The hepatitis A antibody level of all participants exceeded 10 mIU/mL at day 50. While no difference between dosing regimens was found in this study, further research should examine dosing at the lower limit of current Australian recommendations before making policy decisions. The journal of clinical pharmacy 5 July 2024
Hepatitis A virus infection associated with bilateral pleural effusion, ascites, and acalculous cholecystitis in childhood: a case report
Hepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations. Journal of medical care reports 26 June 2024
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Hepatitis B
The cost-effectiveness of universal hepatitis B screening for reaching WHO diagnosis targets in Australia by 2030
The known: Universal screening of all Australians born before 2000 has been discussed as a solution to low rates of chronic hepatitis B diagnosis.
The new: Universal hepatitis B virus screening can be cost-effective in Australia, but requires high levels of engagement by people with hepatitis B with clinical management. Other factors that influence the cost-effectiveness of universal testing are the its cost and the test positivity rate.
The implications: To be cost-effective, universal screening must be based on low cost testing and an effective system for ensuring that people diagnosed receive appropriate clinical management. MJA 3 January 2023
Prevention of vertical transmission of hepatitis B: A retrospective review of a 5-year maternal–infant cohort in London
What is already known on this topic?
What this paper adds
Journal of paediatrics and child health 2 July 2024
‘People like us would have no clue if the information is online’: Exploring understanding and sources of Hepatitis B information among Vietnamese Australians
Socio-cultural and behavioural factors are often not adequately considered in designing health promotion programs for culturally and linguistically diverse communities in Australia. Given that people of Vietnamese background are disproportionately impacted by hepatitis B, the aim of this research was to better understand these factors to inform hepatitis B health promotion messages for the Vietnamese community. Journal of racial and ethnic health disparities 25 June 2024
Australian vaccine preventable disease epidemiological review series: Hepatitis B, 2000–2019
Adolescent and infant immunisation under the NIP has led to significant reductions in notification rates of newly-acquired hepatitis B, and in acute hepatitis B hospitalisation rates, both overall and in Aboriginal and Torres Strait Islander people. Unspecified hepatitis B notification rates have also greatly decreased in children and young adults, likely largely due to the impact of overseas infant immunisation programs on prevalence in child and adolescent migrants. Work to improve completeness of variables within national datasets is crucial, along with enhanced surveillance of both newly-acquired and unspecified hepatitis B cases to investigate transmission routes, vaccination status and factors contributing to acquisition of hepatitis B, in order to optimise the impact of immunisation programs and ensure linkage with care. Communicable diseases intelligence (CDI) 24 June 2024
Evaluating a novel model of hepatitis B care, Hep B PAST, in the Northern Territory of Australia: results from a prospective, population-based study
Hep B PAST is an effective model of care. Partner health services are exceeding elimination targets. This model could enable other countries to enhance the cascade of care and work towards eliminating hepatitis B virus (HBV). The Lancet – regional health Western Pacific 12 June 2024
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Hepatitis C
Hepatitis C treatment hesitancy among people with heroin dependence in Australia. A prospective cohort study
Testing people at risk of HCV infection should be better integrated into opioid treatment programs4 if eradication is to be achieved by 2030. MJA 5 July 2024
Consensus recommendations on the management of hepatitis C in Australia's prisons
Introduction: Prison settings represent the highest concentration of prevalent hepatitis C cases in Australia due to the high rates of incarceration among people who inject drugs. Highly effective direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection are available to people incarcerated in Australian prisons. However, multiple challenges to health care implementation in the prison sector present barriers to people in prison reliably accessing hepatitis C testing, treatment, and prevention measures.
Main recommendations: This Consensus statement highlights important considerations for the management of hepatitis C in Australian prisons. High coverage testing, scale-up of streamlined DAA treatment pathways, improved coverage of opioid agonist therapy, and implementation and evaluation of regulated provision of prison needle and syringe programs to reduce HCV infection and reinfection are needed.
Changes in management as a result of this statement:
The recommendations set current best practice standards in hepatitis C diagnosis, treatment and prevention in the Australian prison sector based on available evidence. Prison-based health services should strive to simplify and improve efficiency in the provision of the hepatitis C care cascade, including strategies such as universal opt-out testing, point-of-care testing, simplified assessment protocols, and earlier confirmation of cure. Optimising hepatitis C management in prisons is essential to prevent long term adverse outcomes for a marginalised population living with HCV. Scale-up of testing and treatment in prisons will make a major contribution towards Australia's efforts to eliminate hepatitis C as a public health threat by 2030. MJA 5 March 2024
Direct-acting antiviral treatments in Australia for children with chronic hepatitis C virus infection
The authors found that the benefits of Direct-acting antiviral (DAA) therapy for children with hepatitis C virus (HCV) infection are now attainable in Australia in normal practice (ie, outside clinical trials). This can be achieved using standard oral preparations, as outlined in the recent Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine guidelines. MJA 16 February 2024
Mortality rates among patients successfully treated for hepatitis C in the era of interferon-free antivirals: population based cohort study
Mortality rates among people successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals are high compared with the general population. Drug and liver related causes of death were the main drivers of excess mortality. These findings highlight the need for continued support and follow-up after successful treatment for hepatitis C to maximise the impact of direct acting antivirals. BMJ 2 August 2023
Integrated Hepatitis C–opioid use disorder care through facilitated telemedicine: A randomized trial
Opioid treatment program–integrated facilitated telemedicine resulted in significantly higher hepatitis C virus cure rates compared with off-site referral, with high participant satisfaction. Illicit drug use declined significantly among cured participants with minimal reinfections. JAMA 3 April 2024
Development of an evidence-based hepatitis C education program to enhance public health literacy in the Australian prison sector: The Hepatitis in Prisons Education program (HepPEd)
Significant gaps in HCV health literacy were perceived amongst the target audience groups. The comprehensive co-design and development processes utilised in HepPEd suggest the program will be well-placed to improve the HCV public health literacy of the prison sector and thereby enhance HCV testing and treatment rates amongst people in prison. International journal of drug policy 5 July 2024
Annual hepatitis C testing and positive tests among gay and bisexual men in Australia from 2016 to 2022: a serial cross-sectional analysis of sentinel surveillance data
The proportion of gay and bisexual men (GBM) with positive hepatitis C virus (HCV) tests has declined, however a substantial proportion are not tested annually. A renewed focus on HCV testing, and treatment where required, is warranted to achieve HCV elimination among GBM in Australia. Sexually transmitted infections 20 June 2024
Missed opportunities: A retrospective study of Hepatitis C testing in hospital inpatients
Increasing testing is key to achieving hepatitis C elimination. This retrospective study aimed to assess the testing cascade of patients at a regional hospital in Victoria, Australia, who inject drugs or are living with hepatitis C, to identify missed opportunities for hepatitis C care. Adult hospital inpatients and emergency department (ED) attendees from 2018 to 2021 with indications for intravenous drug use (IDU) or hepatitis C on their discharge or ED summary were included. Data sources: hospital admissions, pathology, hospital pharmacy, and outpatients. The authors assessed progression through the testing cascade and performed logistic regression analysis for predictors of hepatitis C care, including testing and treatment. Of 79,923 adults admitted, 1345 (1.7%) had IDU-coded separations and 628 (0.8%) had hepatitis C-coded separations (N = 1892). Hepatitis C virus (HCV) status at the end of the study was unknown for 1569 (82.9%). ED admissions were associated with increased odds of not providing hepatitis C care (odds ratio 3.29, 95% confidence interval 2.42–4.48). More than 2% of inpatients at our hospital have an indication for testing, however, most are not being tested despite their hospital contact. As we work toward HCV elimination in our region, we need to incorporate testing and linkage strategies within hospital departments with a higher prevalence of people at risk of infection. Viruses 18 June 2024
Hepatitis C (HCV) reinfection and risk factors among clients of a low-threshold primary healthcare service for people who inject drugs in Sydney, Australia
Hepatitis C (HCV) reinfection studies have not focused on primary healthcare services in Australia, where priority populations including people who inject drugs (PWID) typically engage in healthcare. We aimed to describe the incidence of HCV reinfection and associated risk factors in a cohort of people most at risk of reinfection in a real-world community setting. The authors conducted a secondary analysis of routinely collected HCV testing and treatment data from treatment episodes initiated with direct-acting antiviral (DAA) therapy between October 2015 and June 2021. The overall proportion of clients (N = 413) reinfected was 9% (N = 37), and the overall incidence rate of HCV reinfection was 9.5/100PY (95% CI: 6.3–14.3). Reinfection incidence rates varied by sub-group and were highest for Aboriginal and/or Torres Strait Islander people (20.4/100PY; 95% CI: 12.1–34.4). Among PWID (N= 321), only Aboriginality was significantly associated with reinfection (AOR: 2.73, 95% CI: 1.33–5.60, p = 0.006). High rates of HCV reinfection in populations with multiple vulnerabilities and continued drug use, especially among Aboriginal and Torres Strait Islander people, highlight the need for ongoing regular HCV testing and retreatment in order to achieve HCV elimination. A priority is resourcing testing and treatment for Aboriginal and/or Torres Strait Islander people. These findings support the need for novel and holistic healthcare strategies for PWID and the upscaling of Indigenous cultural approaches and interventions. Viruses 13 June 2024
Applying a stigma and time framework to facilitate equitable access to hepatitis C care among women who inject drugs: The ETHOS Engage Study
Women who inject drugs are significantly less likely to initiate hepatitis C virus (HCV) treatment than men. Concerted efforts are needed to minimise gender-based inequalities in care. The study aim was to use a stigma and time framework to investigate how women who inject drugs experienced HCV care in healthcare settings. International journal of drug policy 10 June 2024
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Hepatitis D
Bulevirtide combined with Pegylated Interferon for Chronic Hepatitis D
The combination of 10-mg bulevirtide plus peginterferon alfa-2a was superior to bulevirtide monotherapy with regard to an undetectable hepatitis D virus (HDV) RNA level at 24 weeks after the end of treatment. NEJM 6 June 2024
Hepatitis D Virus Infection
The overall prevalence of hepatitis D virus (HDV) infection is unknown; however, HBV vaccination is reducing the incidence of HDV infection worldwide. The risk of cirrhosis and hepatocellular carcinoma is higher among patients with HDV infection than among those with HBV monoinfection. NEJM 5 July 2023
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Hepatitis E
Hepatitis E Vaccines updates
The development of a hepatitis E vaccine is imperative given its prevalence and the heightened risk it poses to specific populations. Hepatitis E virus infection, though often self-limiting, poses a significant threat to pregnant individuals and immunocompromised populations. This review delves into the historical trajectory of hepatitis E vaccine development and explores its potential impact on at-risk populations. Historically, efforts to formulate an effective vaccine against hepatitis E have been underway to mitigate the severity of the disease, particularly in regions where the infection is commonplace. As a self-limiting disease, the necessity of a vaccine becomes more pronounced when considering vulnerable demographics. Pregnant individuals face heightened complications, with potential adverse outcomes for both mother and child. Similarly, immunocompromised individuals experience prolonged and severe manifestations of the infection, necessitating targeted preventive measures. This review aims to provide a comprehensive overview of the milestones in hepatitis E vaccine development. By examining the historical progression, we aim to underscore the critical need for a vaccine to safeguard not only the general population but also those at elevated risk. The elucidation of the vaccine’s journey will contribute valuable insights into its potential benefits, aiding in the formulation of informed public health strategies to combat hepatitis E effectively. Vaccines 28 June 2024
Systematic evaluation of guidelines for the diagnosis and treatment of Hepatitis E virus infection
Guideline quality and primary recommendations vary considerably. Refinement by guideline developers and researchers would facilitate updating and applying guidelines for diagnosing and treating hepatitis E virus (HEV) infection. Journal of clinical and translational hepatology 28 June 2024
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This is just a sample of the e-journals the library subscribes to – you will need your library login
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